AB0418 ELEVATED ANA AS A PREDICTOR OF THERAPEUTIC FAILURE TO BIOLOGICAL ANTI-TNF AGENTS IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: F. Liñán Ponce, J. Leiva Goicochea, C. Leiva, D. Sevilla Rodriguez, C. Otoya Guzmán, D. Corro García, J. Rodríguez Baldeón, E. Hidalgo Bravo, G. Obregón Atanacio, I. Loyola Macalapú
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Currently there is no way to distinguish or predict therapeutic failure of Tumor Necrosis Factor (TNF) inhibitors in patients with autoimmune diseases, especially rheumatoid arthritis (RA). Elevated Antinuclear Antibodies (ANA) have been linked as potential markers of therapeutic failure to iTNF. <h3>Objectives</h3> To analyze a possible relationship between high levels of ANA and the presence of therapeutic failure to infliximab (IFX) and Etanercept (ETN) in patients with RA. <h3>Methods</h3> Retrospective cohort study. Two groups were formed: 135 patients with RA and elevated ANA (&gt; 1/80) and 135 patients with RA and negative ANA (&lt; 1/80). All patients received IFX or ETN therapy. ANA was measured before starting therapy. Each group had 60 patients using IFX and 75 using ETN. The appearance of therapeutic failure was expected (DAS28 &gt; 3.2 after at least 3 months of treatment with iTNF). The number of therapeutic failures in each group was counted and then a logistic regression analysis was used with the variables elevated ANA and existence of iTNF therapeutic failure. <h3>Results</h3> Thirty-two therapeutic failures were counted in the elevated ANA group and 16 in the negative ANA group. A higher percentage of failures was observed in IFX users. A higher percentage of therapeutic failure was also observed at a higher ANA level. No relationship was found between the ANA pattern and the presence of failure. The presence of an elevated ANA multiplies by 2.4 the risk of presenting therapeutic failure to IFX or ETN in patients with RA. <h3>Conclusion</h3> An elevated ANA is a predictor of therapeutic failure to IFX or ETN in patients with RA. <h3>References</h3> [1] Yukawa N, Fujii T, Kondo-Ishikawa S, Yoshifuji H, Kawabata D, Nojima T, et al. Correlation of antinuclear antibody and anti-double-stranded DNA antibody with clinical response to infliximab in patients with rheumatoid arthritis: a retrospective clinical study. Arthritis Res Ther. 2011 Dec 22; 13(6):R213. pmid:22192852. [2] Takase K, Horton SC, Ganesha A, Das S, McHugh A, Emery P, et al. What is the utility of routine ANA testing in predicting development of biological DMARD-induced lupus and vasculitis in patients with rheumatoid arthritis? Data from a single-centre cohort. Ann Rheum Dis. 2014 Sep; 73(9):1695–9. https://doi.org/10.1136/annrheumdis-2014-205318 PMID: 24854356. [3] Ishikawa Y, Hashimoto M, Ito H, Tanaka M, Yukawa N, Fujii T, et al. Anti-nuclear antibody development is associated with poor treatment response to biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis. Semin Arthritis Rheum. 2019 Oct 1; 49(2):204–10. https://doi.org/10. 1016/j.semarthrit.2019.02.003 PMID: 30803720. [4] Jani M, Dixon WG, Chinoy H. Drug safety and immunogenicity of tumour necrosis factor inhibitors: the story so far. Rheumatology (Oxford). 2018; 57(11):1896–907. https://doi.org/10.1093/rheumatology/ kex434 PMID: 29325166; PMCID: PMC6199532 [5] Mori A, Saito T, Takahashi M, Shibata M, Tsuji G, Hatachi S, et al. (2020) The presence of antibodies antinuclear is a risk factor for appearance of anti-drug antibodies during therapy with infliximab or adalimumab in patients with arthritis rheumatoid. PLoS ONE 15(12): e0243729. https://doi.org/10.1371/journal.places.0243729 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.